Flores Ismael P, Maciel Alexandre T
Imed Research Group, Hospital São Camilo Pompeia, São Paulo, Brazil.
SAGE Open Med Case Rep. 2020 Feb 7;8:2050313X20904592. doi: 10.1177/2050313X20904592. eCollection 2020.
A few cases of platypnea-orthodeoxia syndrome have been described in the literature, some of them after thoracic or upper abdominal surgeries. In most cases, hypoxemia in the upright or sitting position, which is the main clinical symptom for this uncommon diagnosis, is usually related to a dynamic right to left cardiac shunt induced by anatomical changes in the relative position between the inferior vena cava and the atria in the presence of a patent foramen ovale. In this case report, we describe a situation in which platypnea-orthodeoxia syndrome developed acutely before surgery but that became severely exacerbated after an open urologic surgery without a clear acute anatomical change that could be responsible for triggering the syndrome. This case might suggest that the pathophysiology of acute platypnea-orthodeoxia syndrome is not completely elucidated and that other possible triggers for acute clinical manifestation in addition to acute anatomical thoracic changes must be explored.
文献中已描述了几例平卧呼吸-直立性低氧血症综合征病例，其中一些病例发生在胸外科或上腹部手术后。在大多数情况下，直立或坐位时的低氧血症是这种罕见诊断的主要临床症状，通常与卵圆孔未闭时下腔静脉和心房相对位置的解剖学变化引起的动态右向左心脏分流有关。在本病例报告中，我们描述了一种情况，即平卧呼吸-直立性低氧血症综合征在手术前急性发生，但在开放性泌尿外科手术后严重加重，且没有明显的急性解剖学变化可解释该综合征的触发原因。该病例可能提示，急性平卧呼吸-直立性低氧血症综合征的病理生理学尚未完全阐明，除了急性胸部解剖学变化外，还必须探索其他可能引发急性临床表现的因素。
